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Relationship between Income and Mental Health in the United States
Introduction
Income inequality has become an alarming issue in the United States (Howell, 2014).
Over the past three decades, globalization, technical improvements to production, and weakening
union influence, has caused income inequality to steadily increase (Lowrey, 2014). In 2012 over
half of the income in the United States was earned by the top 10% of earners. This is the highest
level of income inequality ever reported (Lowrey, 2014).
Between 1979 and 2007, there was a 275% increase in household income for the top 1%
of earners, whereas, income for the remaining groups grew much less in comparison. For
example, income for the next 19% of earners grew only 65%. The next 60% of earners, the
largest section in the group, grew less than 40%. The remaining lower income group grew the
least at 18%. Because of these inequities, the top 1% of earners more than doubled their total
after tax income (Wikipedia, 2014). This contrasts with a decline in after tax income among low
and middle income earners. This decline is making the bottom twenty percent of income earners
increasingly susceptible to not earning enough money to live above the poverty line. I suspect
that the stresses associated with being poor may be related to poor mental health outcomes
among low wage earners in the United States (Weigel, 2011).
The current paper examines the association between low income and the prevalence of
mental health issues among Americans in 2012. There have been other studies on income
inequality and mental health in the United States, and there has been mixed results. For
example, a telephone survey of 60 metropolitan areas in the United States was conducted in
1997. However, very few studies, of which I am aware, examine the association between low

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income status and social-emotional distress. The current study attempts to fill this gap in the
literature by examining this relationship using a national representative sample collected by the
2012 General Social Survey.
Income and wealth are forms of human capital. Possessing greater amount of human
capital affords one greater control over one’s life, access to higher quality medical care, affluent
communities with greater amenities, and leisure time (Durden, 2014). Upper income households
are able to spend much more on education, therefore accumulating increased levels of human
capital (Woolhouse, 2014). In contrast, lower income individuals lack human capital, because
they often lack the personal resources for college tuition, and may be reluctant to take on a large
student loan debt, which for many is required in today’s secondary education marketplace
(Woolhouse, 2014). A lack of human capital can create the insecurity of having little control
over one’s life and little or no access to quality medical care. Additionally, low wage earners
may be subject to working longer hours and multiple jobs in order to make ends meet. This can
create a high level of fatigue. Those who lack human capital often are living paycheck to
paycheck and fear of being one disaster away from living on the street. The lack of resources,
little or no medical care, and job insecurity coupled with fatigue may increase the stress and
prevalence of mental health problems among low income individuals. Higher levels of human
capital possessed by upper income individuals increase the ability to overcome stressful periods
in their lives, whereas, lower income individuals often lack the necessary resources to sustain
them.
Additionally, upper income individuals are able to have more social capital (i.e.
relationships for gaining employment, financial help, and increasing social mobility), because

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they possess the resources and relationships that help them remain securely employed and
financially stable. Whereas, lower income individuals lack the resources and relationships to
provide them job security and financial stability. This lack of social capital experienced by lower
income individuals may exacerbate feelings of hopelessness, which in turn may increase the
level of stress and mental problems they experience.
Low income individuals tend to depend upon public mental health services provided by
state agencies such as the Department of Human Services. Unfortunately, funding for benefits
such as Medicaid has been drastically cut. The National Association of State Mental Health
Program Directors (NASMHPD), report that from fiscal year 2009 to 2012 states have cut their
public mental health spending by $4.35 billion dollars. This has resulted in current patients
losing mental health benefits and new patients being refused help (Lippman, 2014). In sum, the
current study examines the extent to which low income status associates with greater mental
health challenges.
Literature Review
Prior research has shown mixed results when looking for an association between income
inequality and poor mental health, although the majority of findings point to a statistically
significant association (Sareen, Jitender. et al. 2011; Sturm, Roland.et al. 2002; K Fiscella, 2000;
Gresenz CR, Sturm R, Tang L. 2001; Kahn et al., 2000; Tama Leventhal, 2003).
For example, a 1997 telephone survey conducted on 60 metropolitan areas in the United
States, looked for the prevalence of four psychiatric disorders, (i.e. generalized anxiety disorder,
dysthymic disorder, major depressive disorder, and panic disorder), and concluded that there was

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no association between income inequality and poor mental health when examining the
prevalence of these specific psychiatric disorders as a dichotomous variable (Sturm, Roland.et al.
2002). I suggest the reason why Strum et al. (2002) found no association between income
inequality and poor mental health is that they only looked for the prevalence of four psychiatric
disorders instead of including symptom of mental distress (Sturm, Roland.et al. 2002).
Other researchers found that there is an increased risk of the occurrence of a mental
disorder and suicide attempts among participants with a household annual income of less than
$20,000, compared with those who had a household annual income of $70,000 or more (Sareen,
Jitender. et al. 2011). Sareen et al. also discovered that when household income is reduced, it
also increases the risk of developing mental health problems (Sareen, Jitender. et al. 2011).
Further support for this increase is shown in that during times of economic recession the amount
of calls to suicide and crisis prevention centers increases. (Sareen, Jitender. et al. 2011).
Friscella found that income inequality showed a statistically significant association to the
prevalence of mental health issues (K Fiscella, 2000). The occurrence of depression was higher
in low income individual compared to those of a higher income (K Fiscella, 2000). Furthermore,
research shows that an individual with low socioeconomic status is at an increased risk of
developing a substance abuse, anxiety, or mood disorder (Sareen, Jitender. et al. 2011).
A 2001 cross sectional study found that it is not the problem of income inequality that
causes an increase in mental health issues, but the problem of low income that causes an increase
in poor mental health (Gresenz CR, Sturm R, Tang L. 2001). Gresenz et al. found a strong
association between low income and poor mental health, and no association between income
inequality and the occurrence of mental health issues (Gresenz CR, Sturm R, Tang L. 2001).

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They reported that the emphasis should be placed upon gaining a better understanding of the
association between low income and poor mental health, rather than changing public policy to
lower income inequality (Gresenz CR, Sturm R, Tang L. 2001).
A 1991 cross sectional study showed that low income women with children showed an
increased risk to developing symptoms of depression (Kahn et al., 2000). Low income women
were 33% more likely to report symptoms of depression compared to their high income
counterparts (Kahn et al., 2000). Unlike Gresenz et al. (2001), this study showed that low
income and living in a state with high income inequality were associated with poor mental health
(Kahn et al., 2000). They found that the effects of living in a state with high income inequality
placed women at a 60% higher risk for developing depression (Kahn et al., 2000). Furthermore,
they reported that low income women with children were at a higher risk for developing
symptoms of depression than the general population (Kahn et al., 2000).
When seeking answers about the effects of low income and high income inequality upon
mental health, we must also consider the situational and environmental effects, especially the
participant’s surrounding neighborhood. Often, these neighborhoods suffer from a high rate of
crime and violence, high unemployment rate, and a high level of welfare recipients (Tama
Leventhal, 2003).
A 2003, three year randomized experimental trial in New York State found that when low
income families were taken out of high poverty neighborhoods, and provided housing in low
poverty neighborhoods significant improvements in mental health were reported (Tama
Leventhal, 2003). When moved from high poverty to low poverty neighborhoods, children
reported significantly lower levels of depression, anxiety, and substance abuse disorders than

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children who were not moved (Tama Leventhal, 2003). Low income parents reported lower
levels of stress and anxiety as well (Tama Leventhal, 2003).
Hypothesis
Poorer individuals are more likely than more affluent persons to report stress, depression
and problems with emotions one or more days a month.
Sample
This study relies upon the 2012 National General Social Survey (GSS), a representative
sample of non-institutionalized persons18 years or older living in the United States. The data
was collected via computer-assisted personal interview (CAPI), face-to-face interview, and
telephone interview. The response rate was roughly 70%.
Measures
Dependent Variable: Mental Health Issues
The mental health issues variable was measured by respondents reporting the presence of
stress, depression and problems with emotions one or more days a month.
Independent Variable: Income
The annual income variable divides the annual household income into quartiles.
Individuals earning between $0 to 25k, are compared to those that earn $25 to 50k, $50 to 110k,
and $110k or above.
Control Variables

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This study also accounts for age, race, gender, education, and region.
Statistical Methods
This study utilizes logistical regression analyses because its dependent variable, mental
health, is dichotomous.
Results
These analyses suggests that the poorest individuals (e.g. $0-25) are more likely than
those of higher incomes to experience at least one day of mental stress during the past 30 days.
Bivariate Analyses
The cross-tabulation analyses listed in Figure 1 indicates that that the poorest Americans,
those that make $25,000 and below, are more likely than all other income groups to experience
stress, depression and problems with emotions at least once month.
Multivariate Analyses
Consistent with the bivariate findings, the logistic regression reported in Table 1 indicates
those that earn 110k or more per year, are less likely than those that make $25k or less to
experience stress, depression and problems with emotions at least once month. In addition,
women the more highly educated are more likely you are to experience stress.
Discussion
This current study examines the impact of income on mental health. This adds to
previous research on income and mental health in that it focuses upon reported mental distress of
at least one day per month. Prior research has shown mixed results when looking for an

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association between income inequality and poor mental health (Sareen, Jitender. et al. 2011;
Sturm, Roland.et al. 2002; K Fiscella, 2000; Gresenz CR, Sturm R, Tang L. 2001; Kahn et al.,
2000; Tama Leventhal, 2003).
This current study found that the poorest Americans are more likely than other
Americans, especially the most affluent, to experience at least one day of mental stress per
month. This is similar to the findings by Sareen, Jitender. et al., which indicate that poorer
Americans are more likely to suffer from depressive symptoms than their higher income
counterparts (Sareen, Jitender. et al. 2011). Similarly, they also found that individuals who
earned less than $20k per year were more likely to develop mood disorders than those who
earned $70k or more per year (Sareen, Jitender. et al. 2011). My study agrees with the Kahn et
al., findings that high income inequality is associated with poor mental health, especially among
poor women (Kahn et al., 2000). Subsequently, K Fiscella, found a small but significant
association between low income and reported depressive symptoms (K Fiscella, 2000).
Conversely, my study did not agree with the findings by Sturm, Roland.et al. that
indicated no association between income and mental health in Americans (Sturm, Roland.et al.
2002). Interestingly, the findings by Gresenz CR. et al., did not agree with my findings when
examining socioeconomic status SES; they found no association between income inequality and
poor mental health, (Gresenz CR, Sturm R, Tang L. 2001).
Nevertheless, Tama Leventhal, found that income and living in a low income
neighborhood is associated with reported levels of distress in low income individuals, which is
plausible in that my study found that the poor experience more stress than other Americans,
especially the most affluent (Tama Leventhal, 2003).

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It is creditable that poor Americans experience higher levels of mental stress because of
the daily pressure to accumulate enough money to survive, i.e. pay rent, buy food, pay utility
bills, etc. (Feeding America, 2014). Additionally, poor Americans living in poor neighborhoods
suffer from blight, lack of safe and productive schools for the children’s education, lack of city
services, especially dependable public transportation for commuting to work (Wikipedia, 2014).
Many work long hours earning minimum wage, and often have more than one job while
struggling to support their families (Murray, 2014). They suffer the anxiety of living in high
crime areas with poor police protection, and the bleak prospect of not being able to find a way to
live above the poverty level (Wodnicki, 2014). Tragically, the number of Americans living in
poverty is increasing and a record number of 47 million now receive food stamps (Boyer, 2014).
It is especially disturbing that 45% of American children live in a low income household
(Nccp.org, 2014).
There is a dire need for increased mental health funding for the poor (Szabo, 2014).
Because of lack of funding for mental health treatment, they often end up receiving inadequate
treatment in county jails or prisons (Carroll, 2014). To address the root of the problem,
lawmakers need to fund more programs that alleviate poverty and address the causes of mental
distress and mental illness (Mukherjee, 2013). In sum, if the poor continue to be neglected, it is
probable that fewer will rise out of poverty, and more will suffer mental distress and declining
mental health.
References

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Figure 1: Impact of Income on Mental Health: Cross Tabulation
Income 0 days of mental stress 1 or more days of mental stress
0 - 25k 38.9% 61.1%
25 - 50k 46.3% 53.7%
50 - 110k 44.2% 55.8%
110k+** 47.3% 52.7%
N= 4820
*<.05; **<.01

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Table 1: Impact of Income on Mental Health: Logistical Regression
Income 1 or more days of mental stress
25 - 50k -.305
50 - 110k -.308
110k+ -.609**
Controls
Age -.009
Degree .197**
Sex .464**
East North Central -.043
Black .080
White .253
Total Sample 4820
*<.05, **<.01